医学
神经科学
神经退行性变
生物标志物
疾病
阿尔茨海默病神经影像学倡议
机制(生物学)
临床试验
神经影像学
标准化
生物信息学
阿尔茨海默病
精神科
计算机科学
心理学
病理
生物
哲学
操作系统
认识论
生物化学
作者
Harald Hampel,Jeffrey L. Cummings,Kaj Blennow,Peng Gao,Clifford R. Jack,Andrea Vergallo
标识
DOI:10.1038/s41582-021-00520-w
摘要
Breakthroughs in the development of highly accurate fluid and neuroimaging biomarkers have catalysed the conceptual transformation of Alzheimer disease (AD) from the traditional clinical symptom-based definition to a clinical-biological construct along a temporal continuum. The AT(N) system is a symptom-agnostic classification scheme that categorizes individuals using biomarkers that chart core AD pathophysiological features, namely the amyloid-β (Aβ) pathway (A), tau-mediated pathophysiology (T) and neurodegeneration (N). This biomarker matrix is now expanding towards an ATX(N) system, where X represents novel candidate biomarkers for additional pathophysiological mechanisms such as neuroimmune dysregulation, synaptic dysfunction and blood-brain barrier alterations. In this Perspective, we describe the conceptual framework and clinical importance of the existing AT(N) system and the evolving ATX(N) system. We provide a state-of-the-art summary of the potential contexts of use of these systems in AD clinical trials and future clinical practice. We also discuss current challenges related to the validation, standardization and qualification process and provide an outlook on the real-world application of the AT(N) system.
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